Eyeworld

EW NEWS & OPINION 14 October 2015 by Vanessa Caceres EyeWorld Contributing Writer details (or know less details) about the surgical procedure with the surgeon's communication style can enhance a positive outcome," Dr. Tovian said. Knowing how much—or little— information patients want about their procedure and tailoring the surgical prep accordingly is crucial, agreed health psychologist Susan Nathan, PhD, Laguna Woods, Calif., as this seems to color patient out- comes. Although certain personality traits or anxiety-type disorders can have an effect on surgical satisfac- tion, Dr. Nathan said that patient ex- pectations will always be high with elective surgery. "If you're paying for the surgery, you want it right," she said. "You have to be clear and cover the bases beforehand." When available, ophthalmol- ogists may want to test patients' possible visual outcomes in advance with a multifocal contact lens to see how they fare, Dr. Nathan said. Increased consultation between ophthalmologists and clinical health psychologists could be a way to assess patient characteristics that correlate with positive surgical out- comes, Dr. Tovian said. Despite the challenges that multifocal IOLs can have, Dr. Packer thinks the discussion of the IOL technology and matching it to patients' goals to be one of the most rewarding aspects of refractive causation for dissatisfaction must be ruled out before personality is implicated," said Mark Packer, MD, chief medical officer, International Biomedical Devices, Mount Pleasant, S.C. Dr. Packer said he tends to agree with the study findings. "I suspect that the use of a validated preoper- ative questionnaire might provide a powerful springboard for the informed consent discussion with patients considering presbyopia-cor- recting IOLs," Dr. Packer said. A detailed preop discussion with patients regarding the possible intol- erance of halos and glare may help patients decide if they can accept the side effects, the authors suggest- ed. This is a part of the pre-surgical process that Dr. Packer thinks is crucial, as it builds trust into the physician and patient relationship. Other factors that ophthalmol- ogists may want to consider that are often related to surgical outcome include patient coping style, patient expectations of the procedure, the surgeon's communication style, and previous patient experiences, said clinical and health psychologist Steven M. Tovian, PhD, associate professor of psychiatry and behav- ioral sciences, Feinberg School of Medicine at Northwestern Univer- sity, Chicago. "For example, match- ing the patient coping style on the dimension of wanting to know more and severe in 12.8% at the 3-month visit. There were no reports of severe glare; 24.6% of patients had some photic phenomena but said that it was tolerable. The results at the 6-month visit were almost un- changed. The percent of patients satisfied or completely satisfied with their surgery increased between the 3- and 6-month postop visit, although it decreased in a group of only moderately satisfied patients. "The small group of unsatisfied patients remained constant," the authors wrote. For the 23 unsatisfied patients, 11 did not use glasses, and 7 had a near and far visual acuity of better than 0.1 logMAR and an astig- matism of less than 1 D. "These 7 patients lay outside the normal range for at least two or more of the compulsive checking, orderliness, competence, and dutifulness person- ality traits. No specific postoperative parameter could explain their dissat- isfaction," the authors wrote. In particular, compulsive check- ing, followed by orderliness, seemed to show a strong correlation with a perception of halos and glare. Weighing in: Patient implications The study results do not indicate that patients with these specific per- sonality characteristics should not have multifocal IOL implantation, the authors concluded. However, they did note that careful patient selection should consider biometry, ophthalmologic findings, preop astigmatism, and personality charac- teristics. "Of course, in cases of patient satisfaction, the main causes (e.g., posterior capsule opacification, dry eye syndrome, and ametropia) should be treated before blaming patients' personality characteristics," they wrote. A validated questionnaire to try and determine who may not be happy postoperatively despite good clinical results would be useful, the authors concluded. "The authors rightly point out that optical and physiological How does personality affect outcomes? W hat sort of patient do you think would not fare well with a multifocal intraocular lens (IOL)? If you guessed someone who favors compulsive checking and or- derliness, then you'd be right. That's according to a study published in the Journal of Refractive Surgery. 1 The prospective multicenter study analyzed personality charac- teristics that may influence patient satisfaction after multifocal IOL implantation. Researchers, led by Ulrich Mester, MD, Saarbrücken, Germany, included 183 patients in the study. They evaluated uncor- rected and corrected visual acuity (UDVA, UNVA, and CDVA) for dis- tance and near before surgery as well as 3 and 6 months postoperatively. Researchers also had patients complete the NEO Personality Inventory test and the Obsessive- Compulsive Inventory test. In these tests, patients were asked about their conscientiousness, orderliness, duti- fulness, achievement striving, delib- eration, self-discipline, and com- petence. During the postop visits, patients completed a questionnaire regarding their surgical satisfaction as well as need for glasses at differ- ent distances. The mean patient age was 62 years old, with 106 females and 77 males. The mean CDVA at 3 months was 0.03 logMAR, the UDVA was 0.05 logMAR, and the UNVA was 0.04 logMAR. At 6 months, with follow-up information from 131 pa- tients, the mean acuities were 0.02, 0.06, and 0.05 for CDVA, UDVA, and UNVA, respectively. Eighty-two percent of patients said they would choose to have a multifocal IOL again; 3.7% said they would not, and 14% were unsure. Overall satisfaction was correlated with low astigmatism, good visual function, low spectacle dependence, and less halos or glare. Halos were noted as slight in 18.4% of patients, moderate in 25%, Assessing who fares best or worst with multifocal IOLs " Matching the patient coping style on the dimension of wanting to know more details (or know less details) about the surgical procedure with the surgeon's communication style can enhance a positive outcome. " –Steven M. Tovian, PhD

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